Chronic diseases, such as heart disease, cancer, stroke, and diabetes, are among the leading causes of death in the United States, accounting for at least 6 out of every 10 deaths each year (Kochanek et al., 2011) and placing a substantial burden on the nation’s healthcare spending (Schoenberg et al., 2007; Vogeli et al., 2007; Cunningham, 2009). The literature on epidemiological, clinical, and laboratory studies linking behavioral risk factors and mortality suggests that poor diet and lack of physical activity are strongly associated with mortality and may soon replace tobacco as a leading cause of death (Mokdad et al., 2004). Poor dietary practices include excess energy intake (Wright et al., 2004), high intakes of saturated fat and sodium (USDA, 2008), and low intakes of fruits, vegetables, and fiber (Serdula et al. 2004; Guenther et al., 2006). Because many risk factors that contribute to the development of chronic diseases, such as poor diet and physical inactivity, are preventable (USDA, 2010b), federal and state agencies have undertaken several initiatives to educate the public about nutrition and health, with the objectives of preventing disease and promoting health. Underlying these efforts is the rationale that an educated public will select healthier diets to reduce the likelihood of premature onset of diet-related chronic disease. This chapter reviews evidence on consumer food choice and barriers to using front-of-package (FOP) nutrition rating systems and symbols, as well as approaches to developing FOP systems by food manufacturers as well as by the U.S. Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS). This chapter discusses the recent proliferation of FOP systems and the impact that multiple types of systems has had on consumer food choice and purchasing decisions. Finally, this chapter concludes by drawing on lessons learned from existing FOP nutrition rating systems and how they can be applied to the development of a more effective system.

Since the passage of the Nutrition Labeling and Education Act (NLEA) in 1990, nutrition labeling has become an important policy tool to provide consumers with nutrition information that will assist them in making nutritionally appropriate food choices and in maintaining sound dietary practices.1 The cornerstone of labeling regulations under the NLEA’s mandate is the Nutrition Facts panel (NFP), an important source of nutrition information that almost all packaged food products are required to carry. By providing information about the nutritional attributes

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4
Consumers’ Use of Nutrition
Information and Product Choices
BACKGROUND
Chronic diseases, such as heart disease, cancer, stroke, and diabetes, are among the leading causes of death in
the United States, accounting for at least 6 out of every 10 deaths each year (Kochanek et al., 2011) and placing a
substantial burden on the nation’s healthcare spending (Schoenberg et al., 2007; Vogeli et al., 2007; Cunningham,
2009). The literature on epidemiological, clinical, and laboratory studies linking behavioral risk factors and mor -
tality suggests that poor diet and lack of physical activity are strongly associated with mortality and may soon
replace tobacco as a leading cause of death (Mokdad et al., 2004). Poor dietary practices include excess energy
intake (Wright et al., 2004), high intakes of saturated fat and sodium (USDA, 2008), and low intakes of fruits,
vegetables, and fiber (Serdula et al. 2004; Guenther et al., 2006). Because many risk factors that contribute to the
development of chronic diseases, such as poor diet and physical inactivity, are preventable (USDA, 2010b), federal
and state agencies have undertaken several initiatives to educate the public about nutrition and health, with the
objectives of preventing disease and promoting health. Underlying these efforts is the rationale that an educated
public will select healthier diets to reduce the likelihood of premature onset of diet-related chronic disease. This
chapter reviews evidence on consumer food choice and barriers to using front-of-package (FOP) nutrition rating
systems and symbols, as well as approaches to developing FOP systems by food manufacturers as well as by the
U.S. Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS). This
chapter discusses the recent proliferation of FOP systems and the impact that multiple types of systems has had on
consumer food choice and purchasing decisions. Finally, this chapter concludes by drawing on lessons learned from
existing FOP nutrition rating systems and how they can be applied to the development of a more effective system.
PROVISION OF NUTRITION INFORMATION AT THE POINT OF PURCHASE
Since the passage of the Nutrition Labeling and Education Act (NLEA) in 1990, nutrition labeling has become
an important policy tool to provide consumers with nutrition information that will assist them in making nutrition -
ally appropriate food choices and in maintaining sound dietary practices. 1 The cornerstone of labeling regulations
under the NLEA’s mandate is the Nutrition Facts panel (NFP), an important source of nutrition information that
almost all packaged food products are required to carry. By providing information about the nutritional attributes
1 Nutrition Labeling and Education Act of 1990. Public Law 101-535, 104 Stat 2353.
33

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34 FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS
of a food in a credible, distinctive, standardized, and easy-to-read format at the point of purchase, the NFP was
anticipated to help consumers choose healthier and more nutritious diets (Guthrie et al., 1995).
The committee identified several studies suggesting a correlation between reading the NFP and engaging in
desired behaviors. Kreuter et al. (1997), for example, showed that label readers have diets that are higher in fruit,
vegetables, and fiber and lower in fat compared to non-label readers. Moreover, among label readers, those with
lower fat diets report looking for fat information more often than those with higher fat diets. Similarly, those with
higher fiber diets report looking for fiber information more often than those with lower fiber diets. Similar results
have been reported by other studies (Kim et al., 2000; Lin and Lee, 2003; Macon et al., 2004; Satia et al., 2005;
Neuhauser et al., 2007). It has also been shown that label users have diets that are lower in cholesterol relative to
non-users (Guthrie et al., 1995). In a review of existing evidence, Kim et al. (2000) concluded that food labels are
indeed useful tools for individuals to make healthier food choices, resulting in better health outcomes. The com -
mittee noted, however, that the studies employed correlative data, which cannot be used to demonstrate a cause-
and-effect relationship between label use and food intake. In particular, because the studies did not account for
selection bias, unobserved individual difference variables might have affected both label use and food intake. For
example, using a quasi-experimental approach to control for unobserved selection effects, Variyam (2008) found
that label use has only a modest association with diet quality. In contrast to Kim et al. (2000), this study found no
evidence that label use is associated with a lower intake of total fat, saturated fat, or cholesterol.
The NFP provides a lot of detailed nutrition information that is likely to be crucial for individuals with dietary
restrictions due to health conditions such as diabetes, hypertension, heart disease, etc. In fact, label readers fre -
quently reported using nutrition labels for the purposes of avoiding certain nutrients and assessing the nutrition
profile (Cowburn and Stockley, 2005). More generally, research on nutrition labeling showed that consumers report
high levels of label use. However, studies that employed verbal protocols (as opposed to self-reports) showed
that consumers simply look at the NFP without processing the information (Higginson et al., 2002; Cowburn and
Stockley, 2005).
A necessary precondition for the NFP’s effectiveness is that consumers use and comprehend the information
on food labels. Evidence reviewed by the committee, however, revealed that actual label use is much less than
what is reported, and that consumers are often confused by the information on the food label and have difficulty
understanding serving sizes (Cowburn and Stockley, 2005). Systematic reviews of studies conducted in the Euro -
pean Union (Grunert and Wills, 2007; Wills et al., 2009) and in Australia and New Zealand (Mhurchu and Gorton,
2007) reached the same conclusions.
Taken together, these studies suggest that consumers may have difficulty understanding the role of various
nutrients and may not interpret the information from the perspective of how nutrients in foods may impact their
daily diet. The literature offers a number of reasons for why nutrition labels are not used by consumers, including
lack of time (Barreiro-Hurle et al., 2010), difficulty with the presentation of information, and lack of understanding
of food label information (Cowburn and Stockley, 2005). In addition, consumers may not understand which nutri -
ents are important, attending solely to fat or calorie information (Higginson et al., 2002). A study by Cowburn and
Stockley (2005) indicated that consumers use numerical information on labels to perform simple calculations, but
their ability to accurately interpret the label declines as the complexity of the task increases, especially consumers
with lower levels of educational attainment.
The Role of Consumer Education Campaigns
Nutrition labeling alone is likely to offer limited success as a strategy to improve the population’s dietary health.
Poor nutrition knowledge may reduce the ability of some consumers to interpret and use the nutrition information
provided. When the NLEA was implemented, the federal government, along with other public- and private-sector
groups, initiated a major multi-year education campaign to help consumers use the new label (Kulakow, 1995).
The goal was to educate consumers about the availability of nutrition information on the food label and about the
importance of using that information to maintain healthy dietary practices. However, the campaign stopped after
the initial years, and nutrition labeling efforts have not been supplemented by other education strategies, which
has resulted in adverse consequences for consumer use of the NFP.

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NUTRITION INFORMATION AND PRODUCT CHOICES
A study by Todd and Variyam (2008) showed that label use declined between 1995-1996 and 2005-2006 for
all population groups, particularly among consumers aged 20-29 years and new residents of the country, who
likely did not benefit from the public awareness and education campaigns that occurred when the new labels were
introduced. Even for the other groups, some depreciation in the value or salience of the information could have
occurred, which highlights the need for new campaigns.
The importance of public education as a supplement to regulation was reinforced when trans fat was added as a
mandatory NFP declaration in 2006. Kozup et al. (2006) stated that without education efforts to increase consumer
understanding of trans fat levels, the new requirement’s effects would be limited. However, FDA had little fund -
ing for education, and the resulting education gap hindered at-risk consumers’ ability to correctly interpret trans
fat levels in terms of their daily diet. Howlett et al. (2008) noted, “[M]aximizing the effectiveness of incremental
additions to the panel depends on a coordinated attempt at educating consumers about the dangers and levels of a
high-trans fat diet.” However, funding for public education efforts to accompany the labeling regulation has been
almost nonexistent.
Barriers to Nutrition Label Use
There are a number of barriers to consumers’ use of nutrition labels. First, a lack of nutrition knowledge is a
major barrier to effective use of the NFP (Barreiro-Hurle et al., 2010) and may actually lower the motivation of
some consumers to use the nutrition information on the food label. In real-world purchase situations, when consum-
ers are pressed for time, the motivation to process and use nutrition information is even more adversely affected
(Grunert and Wills, 2007). This finding has led some investigators to conclude that restrictions in the amount of time
consumers’ have to process nutrition information on the food label limits its effectiveness (Berning et al., 2010).
Other studies reported that some racial groups, e.g., African-Americans, Asians, and Hispanics, are less likely
than Whites to use and understand nutrition labels (Lang et al., 2000; Sullivan, 2003; Satia et al., 2005), primar-
ily because of lack of time to read labels and lack of understanding of the nutrition information. Low numeracy
and literacy skills have also been identified as factors related to poorer understanding of food labels, even after
adjusting for age, gender, education, race, and income (Rothman et al., 2006). A estimated 90 million U.S. adults
have literacy and numeracy skills that are inadequate to function in the current health care environment, so this is
not a trivial problem (IOM, 2004). Adults with low health literacy skills are less inclined to use nutrition labels
and are at greater risk for diet-related health outcomes. Therefore, the nutrition label is not serving the needs of
those who would benefit most from it.
These findings have led to calls to improve nutrition labeling at the point of purchase to encourage selection
of healthier products by consumers (Rothman et al., 2006). Researchers have suggested that interpretational aids
that make the nutrition label easier to use and enhance the ability to compare products may help consumers better
understand how a food product fits into their overall diet (Vishwanathan and Hastak, 2002; Cowburn and Stockley,
2005). A recent systematic review of 58 studies conducted in the European Union showed that consumers favor
simplified information on the front of the package that supplements the more complex nutrition table on the back
(Grunert and Wills, 2007) for the following reasons: (1) they generally do not have time to process detailed nutri -
tion information; and (2) they lack the cognitive skills needed to use the nutrition information to compare products
and interpret the nutrients in the context of their total diet.
In the supermarket shopping environment, consumers often have limited time to process nutrition information,
so they do so in a cursory manner (Higginson et al., 2002). Time constraints highlight the need for a simplified
FOP label that summarizes key aspects of the nutritional profile, is relevant to consumer concerns about diet-related
chronic disease risk, and facilitates product comparisons and healthier food choices. Moreover, understanding such
a label would not require substantial nutritional knowledge, time, and cognitive effort to process, compared to the
NFP, for example. Such a nutrition rating system would be most effective in the supermarket, where consumers
make quick purchasing decisions and must choose from a wide array of products.

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36 FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS
20
18
16
Total Number of FOP Systems (cumulative)
14
12
10
8
6
4
2
0
1987 1990 1993 1996 1999 2002 2005 2008
Year
FIGURE 4-1 Cumulative increase in the total number of front-of-package symbol systems during the past three decades in
the United States.
SIMPLIFYING CONSUMER DECISIONS WITH
Figure 4-1
FRONT-OF-PACKAGE NUTRITION INFORMATION LABELS
R02048
editable vectors
During the past three decades, there has been substantial growth in the number of FOP symbols and rating
systems designed to summarize the nutritional profiles of food products. All of these systems attempt to make the
nutrition information on packages easier to understand and thereby simplify the decision-making process. They
utilize a range of strategies—from simple symbols to more complex and detailed information on key nutrients in
an easier-to-use format than the NFP. They have been developed by food manufacturers and retailers, governments
and nonprofit organizations, industry consortia, and non-industry experts (IOM, 2010). Manufacturers placed
their rating systems on the front of the food package; food retailers placed them on their own store brands or on
grocery store shelves and display cases. The Phase I report provided a timeline for the development of these FOP
systems (IOM, 2010; Chapter 3). Figure 4-1 depicts the proliferation of FOP nutrition rating systems over the
past three decades.
The first FOP nutrition rating systems to appear (during the late 1980s and early 1990s) were largely developed
by nonprofit organizations. In 1987 the American Heart Association (AHA) created the Heart Guide symbol to
signal to the consumer that a food was “heart friendly.” The Keyhole symbol was developed in Sweden in 1989,
and then expanded to Denmark and Norway. In 1995 the AHA developed a new version of its FOP system, the
Heart Check program. The Canadian Heart and Stroke Foundation created the Health Check program in 1999. All

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NUTRITION INFORMATION AND PRODUCT CHOICES
these programs used a single symbol that appeared on qualifying products. At that time, food manufacturers were
not yet involved in the creation of these programs or in the development of the criteria used by them.
Since 2004 the food industry has attempted to respond to the growing consumer interest in nutrition and to
increase the visibility of FDA-approved health and nutrition claims in product packaging and marketing (Kunkel
and McKinley, 2007). Manufacturers and retailers developed FOP nutrition rating systems to provide consumers
with easy-to-use summaries of the nutrition profile of the product and thereby help them make healthier choices.
For example, in 2002 Wegman’s supermarkets developed a series of symbols based on FDA and U.S. Department
of Agriculture (USDA) nutrient content and health claims that were featured only on the store brand products,
effectively differentiating the store brand from competing brands. From 2002 to 2007 other manufacturers, e.g.,
Kraft, General Mills, Unilever, Kellogg’s, and PepsiCo, developed their own FOP systems with the goal of direct -
ing consumers to their healthier food products.
In 2006 the UK Food Standards Agency (FSA) recommended that UK food manufacturers and retailers place
traffic light (TL) labels on the front of food packages to help consumers to make healthier food choices. The label -
ing format consists of four, separate, color-coded lights indicating the level of fat, saturated fat, sugar, and sodium
in the product. Reflecting criteria determined by FSA, a red light indicates a high level of a specified nutrient, an
amber light indicates a medium level, and a green light indicates a low level.
In 2006 algorithm-based summary symbols were introduced into the marketplace. Hannaford Supermarkets’
Guiding Stars system uses a proprietary algorithm; based on both positive and negative nutrients, it gives ratings
of zero to three stars, which are displayed on shelf tags, to foods that meet the minimum nutrient standards. The
NuVal Nutrition scoring system, introduced in 2007, is also based on a proprietary algorithm that considers and
weights both positive and negative nutrients, and presents the final score as a number between 1 and 100.
In 2008 ConAgra introduced the Start Making Choices program, an FOP nutrition rating system based on
USDA’s MyPyramid, which illustrates the contribution of various food groups to a healthier diet. Also in 2008
a consortium of industry, public health, and academic nutrition leaders developed the Smart Choice program, a
summary indicator system. In 2009 the retailer Giant Food introduced the Healthy Ideas program in its Giant and
Stop & Shop stores.
In January 2011 America’s leading food and beverage manufacturers and retailers announced the launch of a
new system, Nutrition Keys,2 which summarizes important nutrition information (calories, saturated fat, sodium,
and total sugars content) on the front of food packages. For some products, the Nutrition Keys icon also displays
information about “nutrients to encourage,” such as potassium, fiber, vitamin A, vitamin C, vitamin D, calcium,
iron, and protein.
In summary, FOP nutrition rating systems and symbols have proliferated since the AHA created the Heart
Guide symbol in 1987. The Phase I committee reviewed 20 systems that were representative of systems that had
been introduced into the marketplace. They fall into three categories: (1) nutrient-specific systems, (2) summary
indicator systems, and (3) food group information systems (IOM, 2010; Chapter 6). Although the systems use dif -
ferent criteria to rate foods, their primary goal is to provide consumers with easy-to-use information that enables
them to quickly determine if a food is a healthy choice and to compare foods within a category. Some systems,
particularly within the food group information category, were found to be more helpful in enabling consumers to
make healthier food choices.
Consumer Research Underpinning the Development of Front-of-Package Systems
As part of its exploratory research into the background of FOP systems, the Phase I committee contacted
several FOP system developers, with the goal of better understanding the (1) rationale behind the FOP systems;
(2) benefits that the FOP systems have provided to consumers; (3) consumer research that preceded and followed
introduction of the FOP systems; and (4) outcomes of these FOP systems. The Phase I committee also conducted
telephone interviews with several representatives from nongovernmental organizations and the food industry. One
of the themes to emerge from these interviews was that food manufacturers were responding to consumer inter-
2 Now called “Facts up Front.”

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38 FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS
est in information. In addition, food manufacturers worked from the hypothesis that consumers shop under time
constraints, and, therefore, designed their FOP nutrition rating systems to provide consumers with information that
they considered to be easily identifiable, accessible, and relevant to making healthier food choices.
The telephone interviews also revealed that most FOP system developers conducted qualitative and quantitative
research to test various versions before choosing the FOP system that performed best with consumers. Impor-
tantly, however, most did not test their systems with non-English speaking or with low health literacy populations.
Moreover, they did not conduct follow-up research to determine whether the FOP systems were being used by
those segments of the consumer population. Regardless of the benefits or limitations of individual FOP nutrition
rating systems, spokespersons for the industry groups and other organizations believed that the type of system they
developed offered the greatest benefit to the consumer. Developers of summary indicator systems focused on the
simplicity of their systems when making comparisons, while developers of nutrient-specific systems considered
fact-based systems to be superior to symbol-based systems. In contrast, developers of food group information sys -
tems asserted that their type of system was best designed to help consumers eat a more balanced diet by making
it easier to track consumption of specific food groups.
Consumer Confusion from Divergent Front-of-Package Systems
FOP systems were developed with the goal of making it easier for consumers to assess information on the
nutritional qualities of a food and thereby facilitate healthier choices. However, in the absence of any consistent
guiding standards, the outcome has been a proliferation of systems based on varying underlying criteria. The report
Food Marketing to Children and Youth (IOM, 2006) expressed concern about the likelihood of consumer confu -
sion surrounding the variety of food rating approaches and recommended that FDA issue guidance on the future
development of FOP labeling and grocery shelf signage systems. Public interest groups have also called on FDA
to develop standards to ensure more consistency across the various voluntary rating approaches, or to mandate the
use of a standard nutrition rating system.
Studies conducted in countries outside the United States provide support for the argument that multiple
rating systems actually confuse the consumer. A review of studies from Australia and New Zealand, for example,
concluded that multiple labeling systems are likely to cause rather than alleviate consumer confusion (Mhurchu
and Gorton, 2007). Research conducted in the United Kingdom also suggested that the presence of multiple FOP
systems causes problems for consumers trying to interpret nutrition information from a label (Clegg and Lawless,
2008; Malam et al., 2009) and called for further research on this topic. In 2009, a study conducted for the UK Food
Standards Agency examined how the existence of a range of FOP label formats impacts accurate interpretation of
FOP labels. Results showed that the coexistence of various FOP labels makes it more difficult and time consum -
ing for consumers to understand the labels and compare products. This report concluded that a standardized FOP
labeling system would enhance consumer comprehension and use of FOP labels (BMRB, 2009).
FDA’s Perspective
FDA shared with the committee information resulting from activities they conducted to improve understanding
of consumer response to FOP nutrition rating systems, including a request for comment, information, and data on
FOP labeling.3 In the committee’s judgment, FOP labeling or corresponding shelf labeling concerning the nutri -
tional attributes of a food product can be an effective way to promote healthier choices and to help consumers to
make food choices that are more consistent with the recommendations of the Dietary Guidelines for Americans.
In its analysis of evidence the committee considered FDA’s appraisal that an FOP or shelf labeling system that
is consistent with the NFP responds to the needs of the market and provides usable nutrition information at the
point of purchase. FDA strongly believes that “the criteria and symbols used in FOP and shelf-labeling systems
be nutritionally sound, well-designed to help consumers make informed and healthy food choices, and not be false
3 75 FR 22602.

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NUTRITION INFORMATION AND PRODUCT CHOICES
or misleading.”4 Finally, FDA expressed concern that the proliferation of competing FOP symbols and systems
could result in consumer confusion and thus be counterproductive.
LIMITATIONS TO A COGNITIVE APPROACH TO FOP SYMBOL SYSTEMS
Over the past several decades, the chief policy response to the problem of poor dietary intake patterns has
been to increase access to information to encourage people to eat a more healthful diet; the NFP and the Dietary
Guidelines for Americans are examples of such efforts. Many of these nutritional strategies have adopted a “cog-
nitive” approach (Petty et al., 2002), which assumes that the consumer is highly motivated to eat a healthful diet
and that access to nutrition information is the main barrier to dietary improvement. Hence, policy initiatives have
focused on providing information to increase consumers’ nutrition knowledge, with the expectation that this will
lead them to select healthier diets.
The results of such an approach have been mixed. On the one hand, there is evidence that some aspects of the
American diet have improved during this period. For example, the percentage of calories from total and saturated
fat has decreased (CDC, 2004), suggesting that the cognitive approach of providing more information has been
somewhat successful. However, during the same period, the average calorie intake has increased significantly
(CDC, 2004), and the sodium intake exceeds the maximum level established by the 2005 Dietary Guidelines
(IOM, 2010). In addition, further improvements are needed even for many dietary aspects that have moved in the
desired direction since the 1970s. An examination of some of the factors underlying food choice provides insights
into the reasons why simply increasing access to information may have only a limited association with dietary
improvement in the population.
“Nutrition knowledge” is only one of the many environmental and individual variables that can affect an
individual’s food choices (Worsley, 2002). In addition to nutrition, taste, cost, and convenience are also significant
predictors of an individual’s food choices. Additionally, different population subgroups can vary in terms of the
importance placed on each of these factors (Glanz et al., 1998; French et al., 1999). For example, individuals in
lower socioeconomic groups and those living in areas without access to a variety of foods may place greater impor-
tance on the availability and cost of food, whereas those who have fewer resource constraints may place greater
importance on the nutritional quality of foods. However, in general, the majority of studies indicate that taste is
a stronger predictor of food choice than health and nutrition; and consumers are most likely to choose foods that
they consider tasty (Aikman et al., 2006; Drichoutis et al., 2006). Additionally, cost may outweigh nutrition in
times of economic hardship, especially for consumers with limited resources. In other words, they may choose the
tastier and cheaper, but less nutritious, food, even though they are knowledgeable about healthy food choices. This
finding is consistent with research by Darmon at al. (2002), who showed that when food selection is constrained
by economic considerations, healthy eating patterns will necessarily be compromised.
In light of this evidence, it is not surprising that the cognitive approach of providing more information about
the nutrition characteristics of a food has not been consistently effective across consumer groups (Baltas, 2001).
As discussed above, certain factors might compromise consumers’ ability to use nutrition information in food
selection, assuming that they are motivated to do so. But motivation is crucial, for without it, nutrition knowledge
has minimal impact on consumers’ food choice and purchasing decisions. Also as discussed above, nutrition
information on food labels is more likely to be read by consumers who are motivated by health concerns, so the
label may indeed assist this group in making healthier food choices. In contrast, cognitive approaches are unlikely
to motivate the use of nutrition information on the food label by consumers who find the label difficult to under-
stand. This is precisely the group that might benefit from an effective FOP system and whose needs are not being
served by the NFP. However, the committee recognizes that any FOP system is likely to have a narrow influence
on the food purchase decisions of consumers whose access or resources to purchase healthier foods are impacted
by economic and/or geographic limitations.
4 Available online: http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/
ucm187208.htm (accessed May 23, 2011).

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40 FRONT-OF-PACKAGE NUTRITION RATING SYSTEMS AND SYMBOLS
FINDINGS AND CONCLUSIONS
Findings
For the past 20 years, food labels have provided nutrition information through a variety of formats at the point
of purchase, with the goal of helping consumers to make healthier food choices. However, concerns remain about
whether nutrition rating systems are actually furthering the NLEA’s goals of encouraging healthier food choice
and purchase behavior. Studies suggest that many consumers have difficulty understanding the NFP and, there -
fore, would prefer a simplified FOP label that provides information that will help them to assess the nutritional
characteristics of the food product.
Conclusions
In response to the perceived need for a better way to convey nutrition information about a food product, food
manufacturers and retailers have developed various FOP nutrition rating systems. However, there is scant evidence
to support that the proliferation of FOP nutrition rating systems has encouraged healthier food choices and pur -
chase decisions. In fact, one UK study of the use of FOP labeling found that the coexistence of a number of label
formats in the market caused consumer confusion about the levels of key nutrients (BMRB, 2009). Thus, there is
a need for a standardized FOP nutrition rating system that moves beyond providing information to encouraging
product comparison and healthier food choices by consumers at the point of purchase. Such an FOP symbol system
could not only help consumers with food choice and purchase decisions, but also serve as a catalyst for product
reformulation, a further benefit to consumers.
Because many consumers have difficulty evaluating product healthfulness based on the NFP, a well-designed
FOP symbol system could be a more effective indicator of product healthfulness. Such an indicator is more likely
to be used by consumers who are less able or less motivated to use the NFP to evaluate the nutritional qualities of
a food product (Zeithaml, 1988; Srivastava and Mitra, 1998). For example, qualitative research in four European
countries has shown that consumers have a preference for a simple FOP symbol system, standardized across food
products (van Kleef et al., 2007). Too much detailed information on food package labels is not useful for consum -
ers who lack nutrition knowledge or have low literacy and numeracy skills (Fuenkes et al., 2008). The need for a
simple FOP symbol system is especially relevant in the grocery store environment, where consumers spend little
time in deciding what to buy (USDA, 2008). Research on consumer use of the NFP and on the recent trans fat
regulation (Kozup et al., 2006; Howlett et al., 2008; Todd and Variyam, 2008) indicate that an FOP system can
only reach its full potential and avoid unintended consequences if it is accompanied by an ongoing public educa -
tion and communication campaign to keep its relevance fresh in the minds of consumers.
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